Published on AEGIS (an EXCELLENT resource for information relating to HIV/AIDS and hepatitis). The increase, however, in TNF suggests use of carnitine to prevent this from becoming a problem. Older studies by de Simone et al showed that use of up to 6 grams of L-carnitine per day could normalize elevated TNF (without wiping out the level if it was within range).
OMEGA-3 FATTY ACIDS SUPPLEMENTATION IMPROVE INFLAMMATION AND ENDOTHELIAL ACTIVATION IN HIV-INFECTED ADULTS ON STABLE ANTIRETROVIRAL THERAPY Antiviral Therapy 2009; 14(Suppl. 2):A37 (abstract no. P-15)
CO Hileman, M O’Riordan and GA McComsey
University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA
OBJECTIVES/AIM: Omega-3 fatty acids in fish oil decrease coronary artery disease (CAD) risk and cardiovascular mortality. This may be due to an anti-inflammatory effect. Inflammation and endothelial dysfunction may play a role in the enhanced cardiovascular risk of HIVinfected patients. Our aim was to evaluate changes in markers of inflammation and endothelial activation in virologically suppressed, HIV-infected adults taking fish oil for 3–6 months.
METHODS: We utilized stored plasma from the Case Center for AIDS Research sample repository. Eligibility criteria included infection with HIV-1, ≥18 years, on stable antiretroviral therapy (ART), HIV-1 RNA 3 months, had stored paired plasma samples from before and 3–6 months after initiating fish oil. We excluded subjects with CAD and active infectious or inflammatory conditions. High-sensitivity CRP (hs-CRP), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), soluble TNF receptors I and II (sTNFR-I and -II), osteoprotegerin, adiponectin, soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) were tested on pre- and post-fish oil samples. The mean of the difference between baseline and follow-up levels were determined for each marker and paired Student’s t-tests or Wilcoxon signed-rank tests were performed as appropriate.
RESULTS: Forty-seven patients met eligibility criteria. hs-CRP (P=0.002), sVCAM-1 (P<0.001) and sICAM-1 (P<0.001) showed a significant decrease after fish oil. The decrease in these markers was independent of changes in total cholesterol, triglycerides, CD4+ T-cell counts, HIV-1 RNA and ART regimens as these did not change significantly over the study period. Although sTNFR-I and -II and IL-6 did not change, plasma TNF-α (P<0.001) increased significantly and adiponectin levels (P<0.001) decreased significantly.
CONCLUSIONS: This pilot study supports our hypothesis that omega-3 fatty acids have potential to decrease inflammation and improve endothelial activation in HIV-infected patients with good virological control.
DISCUSSION: The most significant limitation of this study is that it is an uncontrolled observational study in which the dose, components and adherence to fish oil could not be confirmed and examined in relation to the magnitude of the outcome. Despite this, hs-CRP, sVCAM-1 and sICAM-1 decreased without alternate explanation, results not expected in a population on stable ART with good virological control. However, the same positive effect was not seen for TNF-α or adiponectin. It is possible that despite our careful selection of study participants and samples, there were factors not controlled for that may have contributed to the increase in TNF-α and decrease in adiponectin. One possible explanation is that our entire study population was on ART for the duration of the study. Indeed, in the presence of certain antiretrovirals, increased TNF-α and reduced secretion of adiponectin have been seen in vivo and in vitro.